Rob Hardy: An epidemic proved deadly for Napoleon’s army

August 26, 2009 11:48:00 AM

Rob Hardy - robhardy@earthlink.net

Competent military commanders have known for centuries that disease will take away more of their soldiers than cannonballs or bullets will. There was no truer case of this than that of Napoleon''s Grande Armée, a multinational force of more than half a million men issuing from various nations in Europe with the mission of conquering Russia in 1812. Sure, most people know that the vicious Russian cold froze away any chance Napoleon had for victory, but his losses to typhus had cut his forces drastically long before the winter set in, and typhus kept killing.

In "The Illustrious Dead: The Terrifying Story of How Typhus Killed Napoleon''s Greatest Army" (Crown), Stephen Talty has given the story of how the microbe conquered the army, within the larger story of the brutal and futile Russian campaign. Talty alternates military history and epidemiology, examining the battles but also looking into the command tent and the medical tents. His book contains battlefield descriptions that are often all the more ghoulish for being taken directly from the words of participants on the scene, and presents a vivid picture of the insanity of war.

Napoleon had encountered battlefield disease before, and should have been more respectful when typhus came. His invasion of Egypt in 1798 might have been a disaster anyway because of poor planning, but the classic plague took out thousands of his men. In the 1803 campaign in Haiti, the disease was yellow fever, and was a direct cause of the French defeat. Napoleon was impressed enough with the power of the disease that he sold France''s holdings of New World lands to Thomas Jefferson for a cut-rate price. Still, Napoleon had little respect for doctors: "Medicine is the science of assassins!" he once shouted at a party, and thought that a soldier with sufficient mental fortitude could keep disease away. (He himself had more than his share of medical complaints, but he was no hypocrite; he forced himself to study and work hard no matter how bad he felt.)

He cut back the control that his doctors had over their work, and allowed tyros who had spent three months in medical school to be appointed as junior regimental surgeons. The doctors may have excelled in the manual art of surgery and amputation, but they were hindered by having little idea of the causes of disease. It was miasmas, bad air, that brought diseases, went the medical thinking of the time; gloomy swamps and rotting corpses caused bad smells, and it was those inescapable smells that made for sickness. There was no germ theory, and no realization that it was a bad idea to put, say, wounded soldiers right next to infected ones, and no understanding that stripping the dead of their literally lousy uniforms for reuse was to send the disease to the next wearer.

There was little the doctors could understand about Rickettsia prowazekii, the microbe of typhus. It is primarily carried in lice, and lice are perfectly adapted to battlefield conditions. The microbe kills infected lice, too, but only after five days, days during which the lice''s infected feces can contaminate wounds or be scratched into the body after a louse bite. The bacterium causes swelling and leakage of the body''s cells, so that a host of symptoms can result. An initial giddiness could yield to blinding headache and nausea, incapacitating body pains, fever and chills, ravings, gangrene and death after around 10 days. Patients were in such agony they begged someone to blow their brains out. The mysterious condition ruined the Grande Armée; about 550,000 soldiers began the campaign, and around 500,000 died instead of returning home.

Less than a quarter of these deaths were due to enemy action, the rest being from disease, cold and hunger; the exact number of typhus victims is of course unknown, but it was the most lethal of all the diseases present. Sadly, there was already some understanding of the nature of the disease and how to prevent it. The British physician James Lind, who had experimentally determined that oranges and lemons cured sailors of scurvy, also recommended against typhus that new recruits have their old clothes thrown away and burned, be given hot baths, and be held for quarantine for a few weeks before reporting to their ships. Lind''s recommendations worked, but since experimental medicine was not in accord with traditional medical theories, they didn''t become universally accepted. And even if one of Napoleon''s medical advisors had suggested such steps, Napoleon would have ordered him out of the room. Dr. Larrey, a favorite companion of Napoleon and his surgeon-in-chief, could only guess that typhoid sufferers were dying because of the weather, physical exhaustion and spoiled schnapps.

The disease was hideous, and so was the campaign toward Moscow. The descriptions of battle and the medical treatments of the time are not for the squeamish. Describing the taking of the city of Borodino, Talty writes, "The fort was an abattoir in which the piles of dead told the story of the day like alternating layers of sedimentary soil." Surgeons were working nonstop; Dr. Larrey himself did 200 amputations in the 24 hours after Borodino. Limbs were stacked like lumber. Patients hit in the body were waved away as being beyond any hope of surgical repair, and the "... hopeless cases -- ''horribly disemboweled or mutilated ... motionless, with hanging heads, drenching the ground with their blood'' -- were left to die."

Talty describes one battle after the other, and there are excellent battlefield diagrams to satisfy armchair tacticians who will enjoy the larger view of this particular campaign. He also shows Napoleon at his worst. Napoleon believed in superstition far more than anything his physician advisors could tell him. He repeatedly deluded himself about the strength of his own forces or the weakness of the Russians. He was so self-deluded that entering Moscow, he expected the city''s notables to be there to present him with the keys to the city; instead, they burned it. He was slower to come to decisions than he had been, and his indecisiveness on the field was often fatal. He remained, somehow, a leader beloved by his men, all the way through his disastrous retreat, and into the subsequent battles which would result in his defeat and exile to Elba. Those battles, too, would be lost at least in part to typhus. If there had been no typhus at play on the battlefields, our political world maps would now look completely different.

Talty winds up with the research of Frenchman Charles Nicolle, who in 1909 in Tunisia did classic experimentation to show that the common louse was the key carrier of the typhus microbe. He got the 1928 Nobel Prize for it, and confirmed what was only partially acknowledged in Napoleon''s day: Quarantine and hygiene were the defense against Rickettsia. Nowadays it is easily treated with antibiotics, but science works both ways. Talty concludes with the disclosure that a more powerful typhus germ may well be in military laboratories now, processed into powders or aerosols, ready to enter battlefields again, this time as a weapon.

Rob Hardy is a local psychiatrist who reviews books for a hobby. His e-mail address is robhardy@earthlink.net.

Rob Hardy is a local psychiatrist who reviews books for a hobby. His e-mail address is robhardy@earthlink.net.